[Acute Respiratory Tract Infections/Acute Bronchitis]

Area of Science:

• General Medicine
• Pharmacology

Background:

• Respiratory tract infections and acute bronchitis are frequently treated with antibiotics, despite most being viral in origin.
• Unnecessary antibiotic prescriptions stem from unrealistic patient expectations about symptom duration, particularly for cough.

Purpose of the Study:

• To evaluate the efficacy of antibiotic therapy and symptomatic treatments for acute bronchitis and cough.
• To identify strategies for reducing inappropriate antibiotic prescribing for respiratory infections.

Main Methods:

• Review of existing data on antibiotic use, laboratory markers (CRP, procalcitonin), and symptomatic therapies for acute cough and bronchitis.
• Analysis of evidence for expectorants (Ambroxol, N-Acetylcysteine) and antitussives.

Main Results:

• Antibiotic therapy is rarely indicated for viral respiratory infections; evidence for specific patient groups is lacking.
• Laboratory markers like CRP and procalcitonin have not reliably identified bacterial infections benefiting from antibiotics.
• Peer review and delayed prescribing strategies show promise in reducing unnecessary antibiotic prescriptions.
• Symptomatic treatments, including common expectorants and antitussives, lack robust evidence of efficacy beyond placebo effects.

Conclusions:

• Acute cough, after excluding severe conditions, should be managed with symptom-oriented therapy.
• Current evidence does not support the routine use of antibiotics or common expectorants for acute bronchitis.
• Strategies like peer review and delayed prescribing can effectively decrease unnecessary antibiotic prescriptions.